Let's start off by saying this happened maybe 1 to 1 1/2 months ago when I only had about 2-3 months of nursing experience (I barely have 4 now LOL). I work on a unit where we have no residents, fellows, etc--we only have attendings. It is nice because there is only really one person/line of communication instead of the several that is common on other units here.
Anyway, I was very fresh off orientation when I had a patient seize on me. Basically the MD ordered a bunch of labs to determine why the pt was febrile and seizing. She told me to "hold all the abx before drawing labs" (because she had ordered new abx with the new orders of labs), but I was unsure whether or not to hold the existing abx the pt was already on prior. I asked her this question. Also, when I had figured the pt was febrile, I paged her about it (which she did not respond to) and asked if she wanted to give tylenol. I did feel like I paged her quite a bit, but it was only bc the patient was seizing back to back and becoming febrile--just generally way off his baseline.
I am obviously a very new nurse and this was the first time I had to deal with a patient's escalation of care. I admit maybe I did ask her too many questions...
Well, about a week after this day, my supervisor pulls me in to tell me that this MD complained to her about how I was asking too many questions and (basically saying) that I was annoying her by paging/calling her so many times.
I understand now that I should try to find different resources and ask other nurses questions before I ask the MD. But I also find it weird that she didn't just tell me she had an issue instead of going above me and not informing me I was a problem.
Well, anyway, my supervisor basically said "oh that MD's always like that. she thinks all nurses should be on the same level of expertise. she doesn't understand that newer nurses may not know as much as experienced ones" and she basically said she only told me this out of obligation as she told the MD she would speak to me. I feel better that my supervisor told me she was happy I was asking questions in general and not to take too much offense out of the MDs statement.
However....
I am starting out on a new unit (like brand new! opening up a new gen peds floor) and low and behold, this same MD is going to be one of the only ones there. I already feel really unconfident as a new grad and now I feel super nervous working with her. I haven't had to since that one day. Do you guys have any advice to working with MDs? I feel so insecure and upset. I can't help but feel I'm a bad nurse (apparently she thinks so?)
I did feel like I paged her quite a bit, but it was only bc the patient was seizing back to back and becoming febrile--just generally way off his baseline.
Many times if the MD really doesn't understand what is actually going on with the patient, they will get cranky when asked anything. Don't worry about it. I have had a couple of instances where a physician has been irritable with me but two I remember because they apologized to me in a day or two. Actually one apologized to me, one to my head nurse (I was a new nurse).
You graduated nursing school and are licensed. I am sure you are familiar with looking up medications and their action, normal dose, S.E. etc and don't need instruction on doing that. I will add though, when I could get drug guides on my phone, I was thrilled. What a convenience!
Best wishes on your career. Remember sometimes all it takes is for the attending to be irked with the chief resident, the chief resident is irked at the first and second year residents and you get the grief all that caused.
I think you can totally let go of your awkwardness around working with her on the new unit. She sounds like a busy person who gets annoyed easily, and I’m guessing she has only a vague memory that you bugged her once. My mom told me when I was a kid: “Other people are not thinking about you nearly as much as you think they are.” You’ve been sitting around for weeks stewing about this complaint but I assure you, the MD hasn’t! It will feel a little weird to you when you start working with her, but you’ll move past it quickly and the issue will be forgotten.
Don't be so hard on yourself because you did not understand the orders. Technically the MD should have clarified the orders and there should be a written order of what she verbally told you. And if the patient was seizing back to back, the doctor should not have left the floor before the patient is stabilized. I don't know if she ordered anything for the seizures besides Tylenol to control the temp, but that should have been the priority if the patient was actively seizing. Everybody has a learning curve and you are no exception. Even a seasoned nurse who transfers to a different work area may face challenges.
You just take them as stepping stones and learn from such experiences.
Not a bad nurse.... but utilize your charge nurse for many of those questions. They shouldn't have you floating to a new floor until you have been a nurse for a year
Specializes in Psychiatry, Community, Nurse Manager, hospice.
On 6/19/2020 at 10:53 PM, pinkdoves said:
this is exactly why I asked her the abx question. I asked another nurse and they were unsure (even though this person was a senior nurse) and asked me to ask the doc. In my head I see everyone as equal. I have a hard time thinking MDs are "so above me" that I can't ask them questions. it just seems weird to me...but I understand the hierarchy
MDs are not "so above you" that you can't ask questions.
There are two conversations going on here. One is about new RNs developing knowledge and confidence and the other is about experienced RNs who are stuck in CYA mentality.
You are a new RN developing knowledge and confidence.
Your nurse manager was the right one to field the complaint. She knows what you can reasonably be expected to do in the situation. What was her advice for improvement? I know she said she told doc she would talk to you, but is there anything you can do better next time? Learn to take the note in these situations, without letting it get you down. Be teachable.
I mean, you probably need to sharpen up your communication with docs because most new nurses do. Use SBAR format.
About the other stuff: what were the labs for? Were you drawing for a level of abx? Why do you think you were told to hold the abx? This is something to unpack. This is where your learning needs to come in. You need to know why you are doing what you are doing. Then you won't ask trivial questions.
Did you need a tylenol order or did you already have one? If tylenol is ordered PRN for fever then it isn't doc's job to decide if it's necessary, it's yours. So that may have been annoying for her.
I know you may be stressed having to deal with this one doc all the time, but it's pretty awesome that you will have some consistency for yourself and your patients. You will get used to this doc, even if it turns out that she's just a butthole. Many docs are. It sucks when you are trying to grow, but I'd rather have a competent butthole doc over an incompetent kind doc any day.
Also, when I had figured the pt was febrile, I paged her about it (which she did not respond to) and asked if she wanted to give tylenol. I did feel like I paged her quite a bit, but it was only bc the patient was seizing back to back and becoming febrile--just generally way off his baseline.
How high was the pt's temp? Were they seizing because of the high temp? If so, next time pack them in ice until you get a call back.
Specializes in Clinical Pediatrics; Maternal-Child Educator.
On 6/19/2020 at 9:53 PM, pinkdoves said:
In my head I see everyone as equal. I have a hard time thinking MDs are "so above me" that I can't ask them questions. it just seems weird to me...but I understand the hierarchy
MDs are not "so above you", but you have to realize they also often managing a lot. They need you to be organized when you call them so that you aren't calling them dozens of times for what they will consider to be "little things". This comes with time and experience.
Something I learned as a floor nurse was to ask the provider at what point would they like a call back with an update. Update them on the situation. Read back your orders. Then ask them point blank "This patient is having multiple seizures, when would you like me to call you with an update or are there any specific changes you would like me to call for if they occur?". For instance, call if the seizure is lasting more than x number of minutes or if seizures are occurring more frequently than x number of minutes apart, significant changes in respiratory status, etc. This patient was seizing multiple times. Once this was something the provider was aware of, there isn't a need to call for every seizure unless there is a change. This is one way to get on the same page that will also give you some parameters as a new nurse. It's easy when you're first starting out to get overwhelmed, nervous, and a little scared when a patient is not doing well.
"Hold all antibiotics until labs" means just that. Hold ALL antibiotics. Otherwise, they would have specified to hold X antibiotic until labs.
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londonflo
3,002 Posts
Many times if the MD really doesn't understand what is actually going on with the patient, they will get cranky when asked anything. Don't worry about it. I have had a couple of instances where a physician has been irritable with me but two I remember because they apologized to me in a day or two. Actually one apologized to me, one to my head nurse (I was a new nurse).
You graduated nursing school and are licensed. I am sure you are familiar with looking up medications and their action, normal dose, S.E. etc and don't need instruction on doing that. I will add though, when I could get drug guides on my phone, I was thrilled. What a convenience!
Best wishes on your career. Remember sometimes all it takes is for the attending to be irked with the chief resident, the chief resident is irked at the first and second year residents and you get the grief all that caused.